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NPI Code Detail

MEDICARE: SASHA N BONGORNO

MEDICARE: SASHA N BONGORNO
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1101YM0800XMental Health Counselor

General Provider Information

NPI Number : 1003612375
Entity Type Code : Individual
Provider Name (Legal Business Name) : SASHA N BONGORNO
Provider Business Mailing Address
First Line : 107 MARSHALL ST
Second Line :
City : YELLOW SPRINGS
State : OH
Zip : 45387-1619
Country : US
Telephone Number : 216-212-5856
Fax Number :
Provider Business Practice Location Address
First Line : 10861 YANKEE ST
Second Line :
City : CENTERVILLE
State : OH
Zip : 45458-3574
Country : US
Telephone Number : 216-212-5856
Fax Number :
Authorized Official
Title or Position :
Name :
Credential :
Telephone Number :
Provider Enumeration Date : 02/19/2025
Last Update Date : 02/19/2025

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Directions to “ SASHA N BONGORNO ” Practice Location

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